Laserfiche WebLink
SAN JOAQUIN COUNTY 40 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> '. 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> L!F ORN <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA INSPECTION DgTE <br /> Structure Operation <br /> ❑ ❑ 1. Well Construction PREMISE ADDRESS RE-INSPECTION DATE <br /> ❑ <br /> El 2. Cross-Connection JCJ (� y <br /> Structure Operation Manure Management OW ER/OPERA7 PHONE <br /> El El 3. Spreading and Disking :r , 6_)V&Cl) <br /> ❑ ❑ 4. Concrete Tanks INSP CTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 9. Removal from Premises �kauxSi2b �. <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI , <br /> 11. Fannia Fly I \ <br /> ❑ ❑ 12. Larvae . yw <br /> ❑ ❑ 13. Pupae { <br /> ❑ ❑ 14. Adult \" <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation Feeding/Water LA <br /> ❑ ❑ 18. Water Troughs p <br /> 1:1 El 19. Cups or Bowls �' -le-- 1 C <br /> Fj El 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings <br /> ❑ ❑ 23. Cleanin2 Fre uen <br /> 1 <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection i <br /> Structure Operation Floors '� V <br /> ❑ 3. Properly Graded to Sewer <br /> ❑ ❑ 4. Drain f- �� `/J C3✓ l L <br /> ❑ ❑ 5. Smooth/Cleanable < <br /> ❑ ❑ 6. Covin <br /> 13 ❑ 7. Cleaning Frequency <br /> Structure Operation W811S 3 _ <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure I Operation Cages <br /> ❑ ❑ 10. Condition jam. <br /> 11. Sanitation <br /> Structure Operation Food114 61 ,L4%19 <br /> 4 <br /> 11 E] 12. Storage <br /> El n 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operation Rabies Vaccination RECEIVED ' INSPECT <br /> El El18. Certificate on Premises Ujs <br /> VECTOR CONTROL INSPECTION FORM 79 <br /> EHD 40-06 4/6/12 7 <br /> Page ),Of <br />